The role of percutaneous transluminal coronary angioplasty in heart transplant recipients

Objective: Review the acute and late results of percutaneous transluminal c oronary angioplasty (PTCA) in heart transplant recipients and examine the f actors predictive of restenosis. Background: Coronary graft disease (CGD) is the main factor responsible for late graft loss. Medical treatment, surgical revascularization, or retrans plantation gives only suboptimal results in this regard. Therefore, PTCA ha s been attempted in this situation. Methods: More than 332 heart transplantations in our institution have been performed since 1992, the date of the first PTCA in our patients. We are cu rrently in charge of 450 patients. All the characteristics, procedure-relat ed information, and clinical outcome of patients needing PTCA were assessed by review of each patient's clinical records. Ail coronary angiograms were reviewed by an independent cardiologist. Results: Since 1992, 53 coronary sites have been dilated in the course of 3 9 procedures in 29 patients. Indication for PTCA was asymptomatic angiograp hic coronary graft disease in 35 sites (64.8%), angina in 9 (16.6%), silent ischemia in 2 (3.7%), acute myocardial infarction in 1 (1.8%), and CHF in 7 (12.9%). Primary success (<50% residual stenosis) was obtained in 50 (94. 3%) of 53 lesions. No periprocedural death occurred. Procedural complicatio ns were 1, transient acute renal failure and 1 persistent bleeding at the p uncture site. Six months restenosis rate (defined as percent stenosis >50%) was 32.5% (14/43). Mean follow-up was 1.27 year +/- 1.2 (SD). Five deaths (17.2%) occurred in follow-up and were all in relation to coronary graft di sease. Mean time separating PTCA from death was 0.9 year +/- 1.3 (SD). We a lso sought to look at factors predictive of restenosis. By multivariate ana lysis, a positive recipient's serology for cytomegalovirus (CMV) before the graft was the only factor found protective against restenosis (odds ratio 22.4; confidence interval 1.1 to 443.4). Conclusions: PTCA in heart transplant recipients allows a high level of pri mary success with a low periprocedural-complication rate. Restenosis rate s eems equivalent to restenosis rate in native coronary arteries. Mortality d uring follow-up is increased in this population and is the consequence of a high level of coronary events. Recipient positivity for CMV before the gra ft is associated with a protective effect from restenosis.